by Courtenay Vickers, RD
The Aleo Collective
Conversations about food, weight, and bodies show up more often in practice than we might expect. As a Registered Dietitian who works closely with individuals in eating disorder recovery, I know firsthand how much a provider’s language and cues can shape a client’s sense of safety. Before we can support clients struggling with food and body concerns, we need to reflect on our own beliefs.
Now of course, I’m writing this as a dietitian who inherently will be talking about food much more directly than most social workers. And it’s important for my social worker colleagues to recognize that even when there’s an RD on the team, the way you talk about (or avoid talking about) food and body still matters — your words can either reinforce shame or open the door to healing. In this article, I’ll share more about how to examine our own biases around food and body, what that means for our clients (with and without eating disorders), and how to move forward while upholding dignity and safe practice.
Self-reflection
Let’s take a moment to do your own self-reflection about food and body. You might want to pull out a pad of paper for these questions. Before we get started, it’s important to know that how you approach clients (with or without eating disorders) can be influenced by your own relationship with food, body image, and assumptions about health. Now, take a moment to reflect on these key questions:
- How has your relationship with food and your body influenced how you view and work with clients as a social worker?
- Have you ever made assumptions about a person’s health or behaviours based on their weight? How could this affect your care?
- How do you interact with people in larger bodies? Do you notice any differences in how you approach folks in smaller bodies vs larger bodies?
Why does self-reflection about food and body matter?
As all good social workers already know, self-reflection is the practice of examining your own assumptions, biases, and lived experiences, and considering how they influence your work. When it comes to food and bodies, this becomes especially important. We all live in a society obsessed with diet culture, where we are saturated with messages about dieting, “healthy” eating, and weight loss. Unfortunately, these messages disproportionately harm folks in larger bodies and can spur and perpetuate disordered eating, sometimes leading to a diagnosable eating disorder. These beliefs can shape the way we, as clinicians, view and respond to our clients.
For example, I’ve had clients who were told to “just lose weight” when they expressed feeling unhappy about their body size. Perhaps this clinician has engaged in dieting themselves, and they believe it’s something that “works” for everyone. This advice may have been well-intentioned, based on the belief that weight loss can resolve poor body image. In reality, research shows that 95-98% of weight loss attempts through dieting are not sustainable. And importantly, weight loss does not resolve body image distress in the long term. In my experience, clients who are told to lose weight have usually already tried this — often dozens of times. They’ve tried fad diets, “watching what I eat,” calorie counting, exercise. None of this is new to them. Telling someone to lose weight, especially without understanding their relationship with food, access to food, and beliefs about body size and health, can quickly become the catalyst for an unhealthy relationship with food, or even the onset of an eating disorder.
Research shows that weight stigma in healthcare, like in the example above, is linked to poorer health outcomes, increased shame, and barriers to seeking support. Given that eating disorders affect nearly 2 million Canadians (and disordered eating is even more widespread), every interaction matters.
For anyone wanting to dig deeper into understanding their own attitudes and beliefs about weight, I highly recommend taking the Weight Implicit Association Test (IAT). By examining your own biases, you are taking an important step forward to reducing the negative effects of diet culture, weight stigma, or shame in your work. You also create a safer environment for clients to share their experiences openly. This is particularly vital for clients living in larger bodies, for those with eating disorders, and for anyone navigating body image distress.
What this looks like for you and your clients
When I reflect on my own journey as a clinician (specifically as a Registered Dietitian who now works in the eating disorder field), I see how my personal relationship with food and my body influenced the way I showed up for clients early on. It’s uncomfortable work, and being willing to learn and unlearn these biases has helped me offer care that is both more compassionate and more effective.
For social workers, this self-awareness strengthens your therapeutic presence. It helps you recognize when a reaction may be about your own internalized beliefs, rather than your client’s needs. It also creates more room for curiosity — try asking yourself, “how is food showing up in this person’s life?” instead of making assumptions.
Imagine the incredible shift that can take place in your client interactions when you start asking questions like:
- “What was food like for you growing up?” – This can be a powerful question to explore.
- “What does ‘healthy eating’ mean to you and your family?” – There is no one specific way to define ‘healthy eating’, meaning it will look different from one person to the next.
- “What kind of resources do you have to access food?” – This may reveal food insecurity, transportation limitations to acquire food, and barriers to cooking.
You might not have all the answers or know exactly what to do next, but holding space for a nonjudgmental conversation about food can go a long way and be an incredible foundation of rapport.
Actionable steps for clinicians
Working with eating disorder clients doesn’t mean you have to know everything, but there are clear steps you can take to provide meaningful support:
- Learn as much as you can about eating disorders, disordered eating, and diet culture. Expand your knowledge by reading books like Sick Enough by Dr. Jennifer Gaudiani, Life Without Ed by Jenni Schaefer, and The Body Is Not an Apology by Sonya Renee Taylor. Food Psych by Christy Harrison is a wonderful podcast to learn more from. A great Canadian website about eating disorders that we often recommend is the National Eating Disorders Information Centre (NEDIC).
- Self-reflect. Ask yourself hard questions. How do my own food and body experiences shape the way I see my clients? What words am I using to describe food? Do I describe foods as “healthy” or “junk”? Do I comment on body size, even casually? Remember, the way you talk about your own body and food habits can influence others.
- Practice active listening, especially when exploring someone’s relationship with food and body. Validating a client’s feelings and experience can be incredibly powerful.
- Collaborate with a team. You don’t have to know everything; the best care for eating disorders and disordered eating is often multidisciplinary. Work with dietitians, therapists, and medical professionals to ensure comprehensive care. If a client doesn’t have a team, help build a team or consult with other eating disorder professionals.
- Refer when necessary. Know the options for higher levels of care and how to connect clients. If waitlists are long, continue supporting your client with compassion and harm-reduction strategies.
- Advocate for your clients. Advocacy can make a huge difference, whether it’s within the healthcare system, with family members, or through education about eating disorders in your community.
The words we use, and how we talk about food and body, matter; they can either reinforce shame and stigma or open a space for curiosity, understanding, and healing. By bringing awareness to your own beliefs about food and bodies, you can reduce harm and create space for your clients with eating challenges to feel seen and supported.
COURTENAY VICKERS (she/her) is a Registered Dietitian living and working on the traditional territories of the Erie, Neutral, Huron-Wendat, Haudenosaunee and Mississaugas, presently known as the City of Hamilton, Ontario. Courtenay focuses on eating disorder care through her virtual private practice. She provides compassionate, recovery-oriented nutrition support for adults navigating eating disorders and disordered eating, including anorexia, bulimia, binge eating disorder, ARFID, and body image concerns. Her work is rooted in a weight-inclusive, Health at Every Size® approach that challenges diet culture norms and helps clients heal their relationships with food and body. Courtenay is registered with the College of Dietitians of Ontario and is an active member of The Aleo Collective.